Cost-effectiveness of a real-time spatiotemporal mapping surveillance system for meticillin-resistant Staphylococcus aureus prevention

Objectives: An infection surveillance system based on a hospital's digital twin [4D -Disease Outbreak Surveillance System (4D -DOSS)] is being developed in Singapore. It offers nearreal -time infection surveillance and mapping capabilities. This early economic modelling study was conducted, using meticillin-resistant Staphylococcus aureus (MRSA) as the pathogen of interest, to assess the potential cost-effectiveness of 4D -DOSS. Methods: A Markov model that simulates the likelihood of MRSA colonization and infection was developed to evaluate the cost-effectiveness of adopting 4D -DOSS for MRSA surveillance from the hospital perspective, compared with current practice. The cycle duration was 1 day, and the model horizon was 30 days. Probabilistic sensitivity analysis was conducted, and the probability of cost-effectiveness was reported. Scenario analyses and a value of information analysis were performed. Results: In the base -case scenario, with 10 -year implementation/maintenance costs of 4D -DOSS of $0, there was 68.6% chance that 4D -DOSS would be cost-effective. In a more pessimistic but plausible scenario where the effectiveness of 4D -DOSS in reducing MRSA transmission was one -quarter of the base -case scenario with 10 -year implementation/ maintenance costs of $1 million, there was 47.7% chance that adoption of 4D -DOSS would be cost-effective. The value of information analysis showed that uncertainty in MRSA costs made the greatest contribution to model uncertainty. Conclusions: This early -stage modelling study revealed the circumstances for which 4DDOSS is likely to be cost-effective at the current willingness -to -pay threshold, and identified the parameters for which further research will be worthwhile to reduce model uncertainty. Inclusion of other drug -resistant organisms will provide a more thorough assessment of the cost-effectiveness of 4D -DOSS. 2023 Published by Elsevier Ltd on behalf of The Healthcare Infection Society.